Payment

Please Complete All Appropriate Fields
1. U.S. SOCIAL SECURITY NUMBER (US Students)

2. FIRST NAME LAST NAME

If any of your transcripts, test scores, etc. might arrive under any name(s) other than those listed above, enter name(s) here:

3.NUMBER AND STREET ADDRESS
CITY STATE Choose Outside USA Alabama Alaska Arizona Arkansas California Colorodo Connecticut Deleware Dist. Columbia Florida Georgia Hawaii Idaho Illiniois Indiana Iowa Kansas Kentucky Louisianna Maine Maryland Massachusettes Michigan Minnisota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP
COUNTY PROVINCE COUNTRY
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ALTERNATE TELEPHONE

4. ALTERNATE ADDRESS Check here if same as current address

NUMBER AND STREET ADDRESS CITY COUNTY PROVINCE COUNTRY ZIP (Full Address)

5. APPLICATION DATE:

6. COSTS

FINANCIAL PLAN & FEES
CHRISTIAN ENDOWMENT AMOUNT
________OTHER COSTS
________ COST FOR CDS/DVDS/TAPES/BOOKS/COPIES
_________AMOUNT PER MONTH
_________TOTAL COST PER DEGREE - SEE CATALOG

*SEE REFUND POLICY
** See Terminate/cancel Policy

7. STUDENT SEEKING FOLLOWING DEGREE:
__Associate of Christianity (60)
__Associate of Christian Pastoral Copy of the binding document Bible Counseling (60)
__Bachelor of Theology (120)
__Bachelor of Christian Bible Counseling (120)
__Master of Christian Bible (86 plus thesis)
__Master of Christian Pastoral Bible Counseling (86 plus thesis)
__Doctor of Divinity (100)
__Biblical Archaeology (30+)
__Non Degree Seeking

MAJOR:_________________

8. SEX

9. DATE OF BIRTH: Year 20_____
PLACE OF BIRTH:

10. DISABILITY STATUS:
In order to provide services to disabled students, the College is asking for VOLUNTARY Self-identification of students with a specific disability. This information will be confidential and will be used for the sole purpose of aiding to achieve his/her fullest potential.
__Physical Impairment (P)
__Speech Impairment (S)
__Hearing Impairment (H)
__Visual Impairment (V)
__Learning Impairment (L)
__Other Health Impairment (O)

11. Your Signature is proof that you have received and read a copy of the binding document and catalog.
__JULY (START___END____)

12. HIGH SCHOOL DATA _____________________________________Date of Graduation___/______
NAME OF HIGH SCHOOL CITY/STATE MO. / YEAR

13. GED DATE State of Issue_________________English Version __Yes __No Date of Issue___/_____

14. COLLEGE/UNIVERSITY List all post secondary colleges or universities you've attended.
Omission of any constitutes falsification of records and voids application.
NAME OF INSTITUTION CITY/STATE DATES DEGREES CREDIT
____________________________________________________________________________________
____________________________________________________________________________________
ATTACH ON SEPARATE PAPER LIST OF ANY OTHER ACCREDITED UNIVERSITIES, ETC.

15. I understand that falsification or omission of any information may result in my rejection or
dismissal by the college.

16. PLEASE SEND IN TRANSCRIPTS._______________________________ DATE_______________
INKED SIGNATURE OF APPLICANT